Photo Credit: Svitlana Hulko

 A recent study showed that ultrasound reduces peripheral venipuncture pain and yields better patient experiences compared with the conventional method.

Ultrasound-guided peripheral venipuncture performed by a specialist improved patients’ experiences and lessened their pain during the procedure, according to findings recently published in the Journal of Infusion Nursing.

“The PRECISE trial was prompted by the hypothesis that assessment of patient experience during common invasive procedures with the potential to cause pain, such as peripheral venipuncture, can be a determining factor in improving technical aspects and reducing patient discomfort,” Eneida Rejane Rabelo-Silva, RN, MSc, ScD, of the Nursing School at Universidade Federal do Rio Grande do Sul, Brazil, told Physician’s Weekly.

“Providing the best possible experience for patients requiring vascular access entails incorporating novel technologies and adopting best practices. Specialist nurses working in vascular access teams enable ultrasonography in routine practice, improving the accuracy and success rate of vascular access procedures and leading to a more positive patient experience.”

The researchers carried out a parallel, randomized, controlled trial at a single center, Hospital de Clínicas de Porto Alegre in Porto Alegre, Brazil. Rabelo-Silva and colleagues randomly assigned volunteer patients who required peripheral IV cannulation (PIVC) to undergo the procedure in one of two ways: the intervention procedure, ultrasound-guided PIVC conducted by a specialist nurse, or the control procedure, conventional PIVC by a nonspecialist nurse on the hospital’s staff. A member of the research team who was not involved in data analysis collected information at baseline and during the procedure, monitoring patients for adverse events that could be attributed to the method of venipuncture. The data they collected included patients’ baseline characteristics, insertion data, information about the medications used, and details about the patient’s experiences as measured by a verbal numerical rating scale and net promoter score.

The main outcome was pain on a scale of zero (no pain) to 10, and the net promoter score, which asked patients a single question: “How likely are you to recommend this procedure (to another person who may need it)?” Rabelo-Silva and colleagues sorted responses into three categories: active promoters, who would encourage others to get the procedure; passive promoters, who were satisfied with the outcome but would not recommend it; and detractors, who would discourage others from undergoing the procedure. The secondary outcomes were peripheral venous catheter dwell days and related complications, including extravasation, infiltration, obstruction, and phlebitis.

A total of 64 patients participated, with 32 assigned to each group. Researchers stratified the patients by age, with one block of patients aged 18 to 59 and another block aged 60 and older.

Patient Experiences With Venipuncture Methods

More than three-quarters of patients in the ultrasound-guided group reported that they experienced no pain or only mild pain, Rabelo-Silva and colleagues wrote (78.1%, n=25), whereas, in the intervention group, most patients reported experiencing moderate to severe pain (n=21, 65.7%; P<0.001). The mean overall pain rating was 2 in the intervention group versus 4 in the control group. The researchers added that patients assigned to ultrasound-guided PIVC were 67% less likely than the control group to experience moderate or severe pain (95% CI; 0.17-0.67).

Rabelo-Silva and colleagues reported that nearly all patients in the ultrasound-guided group (n=29, 90.6%) were active promoters of the procedure. All others were passive promoters (n=3, 9.4%). About one-third of patients in the conventional PIVC group said they would recommend the procedure (n=11, 34.4%), whereas (n=5, 15.6%) were detractors, and half (n=32, 50%) were passive.

“The findings of this study provide important evidence that point-of-care ultrasonography – a risk-free, non-invasive procedure – can benefit patients during various bedside procedures and can be an effective adjunct in daily clinical practice,” Rabelo-Silva and colleagues explained.

“Patient experience is of inestimable value to continuous quality improvement in healthcare, especially in hospitals and other inpatient facilities. Outcomes can be linked to care quality and serve as institutional indicators of patient-centered care. USGPIV by specialist nurses improves care quality, patient safety, and patient experience. It is essential that nurses be offered specialist training in a wide range of fields as a means of improving their technical capabilities and scientific knowledge and, ultimately, enhancing patient outcomes.”

Improving a Common Procedure

Rabelo-Silva and colleagues noted that because PIVC is so common, it is an overlooked invasive procedure. However, it is so common that clinicians should be thoroughly trained and given ongoing education on the procedure.

“Peripheral vein cannulation and intravenous drug administration are often overlooked as simple routine procedures,” Rabelo-Silva says. “It is precisely because they are so frequent and so often taken for granted that these interventions warrant particular attention and a critical outlook on how they are being performed and what impact they are having on patients. It is not unusual for actual clinical practices to vary in consistency and stray from recommended standards of care.”

The researchers added that future research should use a variety of study methods to ensure robust data and include diverse groups of patients.